Acne vulgaris can be easy to diagnose yet difficult to evaluate and manage, especially when it presents in infancy and childhood. The differential diagnosis of acne varies by age and, in some cases, may warrant a work-up in order to rule out underlying systemic abnormalities. Likewise, treatment strategies can be influenced by the patient's age. In this article, we present an overview of the clinical presentations of acne by age, an approach to patient evaluation, and a general strategy for management of this common and important disease.